Provider Demographics
NPI:1962485250
Name:CRISS, CYNTHIA A (LPC,)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:A
Last Name:CRISS
Suffix:
Gender:F
Credentials:LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E SHEA BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6048
Mailing Address - Country:US
Mailing Address - Phone:602-677-3557
Mailing Address - Fax:
Practice Address - Street 1:4545 E SHEA BLVD STE 235
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6048
Practice Address - Country:US
Practice Address - Phone:602-677-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10792174400000X
AZLPC-10792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist